Why Physical Therapy After Surgery

Why Physical Therapy After SurgeryTop 10 reasons to attend physical therapy after surgery:

  1. Pain/inflammation reduction (Phys Ther J 2010, 2014)
  2. Strength restoration, especially after joint replacement (JBJS 2008, 2010)
  3. Functional restoration, especially after heart surgery (J Cardiol 2001, 2016)
  4. Flexibility restoration, especially after joint surgery (Arch Phys Med Rehab 2009)
  5. Endurance restoration (New Eng J Med 2011)
  6. Balance restoration, especially after foot/ankle surgery (Geriatrics 2007, 2012)
  7. Injury prevention (Phys Ther 2004, 2008)
  8. Posture restoration (Sp Med 2000)
  9. Obtain customized fitness program for life
  10. Improved surgical outcome (J Card Rehab 2006, Arch Phys Med Rehab 2011)

A reader writes:

I had my knee replaced a year ago and have less pain, but I’m struggling to get full motion and strength back.  I’m limping, stairs are hard (especially descending) and my low back hurts (maybe from walking differently since surgery?).  I had physical therapy after surgery, but I don’t think it did enough.  What else can I do?

I recommend two things:

  1. Schedule a follow up with your surgeon.  You need to make sure no problems exist with your implant, so your surgeon should examine your knee and order imaging if he/she feels it’s warranted.   Hopefully, a total knee replacement (TKR) revision (i.e., “redo”) won’t be needed, as revisions are difficult to do, infection-prone and problematic for patients in terms of morbidity.  Paul M. Puziss, MD, an orthopedic surgeon in Beaverton, states, “No surgeon wants a patient to go through a TKR revision, as it is a hardship on the patient in many aspects.  They are also more difficult to do than the original procedure, have a higher complication risk and cost more.”
  2. Find a physical therapist (PT) that specializes in exercise therapy (especially strengthening) to start a new care plan.  It doesn’t sound like you were happy with your post-op physical therapy.  Following TKR, it’s crucial that your physical therapist safely pushes you during every session to increase flexibility and strength in all your leg muscles, especially your thighs.  Recent studies in Arthritis Care and Research (2013, 2015) showed that patients who underwent aggressive strengthening and stretching following TKR functioned much better than controls at 12-month follow up, such as ability to climb stairs and rise from a chair.  A key exercise during rehab is the squat, but care must be taken to perform it precisely to minimize forces on the knees and low back.  Notice in the picture the angle of knee bend and upright posture, both of which maximize work of the hip and thigh muscles while minimizing joint forces:

To help you expedite less painful exercise in PT, your surgeon may recommend getting an anti-inflammatory injection, according to Dr. Puziss.  “Getting a TKR is only half the battle against severe osteoarthritis (OA).  The other half is the doctor and physical therapist helping the patient adopt a healthy lifestyle that includes strengthening, endurance exercise, stretching, a sound diet and quality rest.” 

Research shows a correlation between obesity and TKR incidence, and TKR implants wear down faster in patients who are obese (Arch Phys Med Rehab 2014).  Therefore, many surgeons won’t consider TKR surgery until an “acceptable” fitness level is achieved.

If you have knee OA and are considering TKR, your doctor should recommend conservative care first as research shows exercise can be a powerful OA antidote, delaying and possibly preventing the need for a TKR (New Eng J Med 2010).  As always, the main determinant of success will be your willingness to take an active role in your care because even the best physical therapist can’t do the work for you.

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